Stigma, HIV/AIDS and prevention of mother-to-child transmission in Zambia

This report evaluates the extent of perceived and enacted HIV/AIDS-related stigma in a rural setting in Zambia. Stigmatisation is abundant, ranging from subtle actions to the most extreme degradation, rejection and abandonment. Women with HIV and pregnant women assumed to be HIV positive are repeatedly subjected to extensive forms of stigma, particularly once they become sick or if their child dies. Despite increasing access to prevention of mother to child transmission initiatives, including anti-retroviral drugs, the perceived disincentives of HIV testing, particularly for women, largely outweigh the potential gains from available treatments. HIV/AIDS related stigma drives the epidemic underground and is one of the main reasons that people do not wish to know their HIV status. Unless efforts to reduce stigma are, as one peer educator put it, “written in large letters in any HIV/AIDS campaign rather than small”, stigma will remain a major barrier to curbing the HIV/AIDS pandemic.     

The African Evaluation Guidelines: 2002. A checklist to assist in planning evaluations, negotiating clear contracts, reviewing progress and ensuring adequate completion of an evaluation

A review of the US ‘program evaluation standards’ (PES), undertaken in a series of workshops and meetings of networks of evaluators in Africa, resulted in modifications to those standards. The result was presented to a plenary session of the Inaugural Conference of the African Evaluation Association in September 1999, attended by over 300 evaluators from 35 countries. The AfrEA Conference decided that a systematic effort should be made to produce a list of African evaluation guidelines, similar to the PES, and that this checklist should be reviewed by national evaluation associations and networks in Africa and field tested in several countries. Ten national and regional networks and associations suggested modifications to the text and endorsed the final version of the guidelines.     

Monitoring and evaluation of loveLife's AIDS prevention and advocacy activities in South Africa, 1999–2001

loveLife is the largest effort ever launched in South Africa to change adolescent sexual behaviour with the aim of reducing the rate of HIV infection among 15–20 year olds by 50%, reducing other STIs, and reducing the incidence of teenage pregnancy. loveLife combines high-powered media awareness and education, development of adolescent-friendly reproductive health services, and outreach and support programmes. The 5-year research and evaluation plan includes a multi-year comprehensive observational study, tracking change in a range of behavioural indicators and in sexual health outcomes. In its first 2 years, loveLife reached more than 4 million youth. Sixty-two percent of youth and 59% of their parents/guardians recognize the brand, while the vast majority of parents (97%) and youth (89%) exposed to loveLife, identified loveLife as being positive. Challenges in the next years are the continued roll out of the programme, and the development of institutional support and behaviour change.     

Zimbabwe's AIDS action programme for schools

AIDS education started very early in Zimbabwe and is now compulsory in all schools. This evaluation documents the development of the primary and secondary school AIDS Action Programme from 1991 to 1998. Six programme aspects were evaluated: programme start-up, planning and management, development of syllabi and materials, teacher training, research, monitoring and evaluation, and co-ordination. The Programme drew on resources from within the existing educational system. Due to broad-based consultation and participation, it was supported by Government and partners. Flexible management ensured implementation of mid-course corrections. It was concluded that school AIDS programmes should stress participatory teaching and learning methods and life-skills training. Curriculum writers and teachers needed training and supervision in participatory techniques. Cluster workshops between district and school levels were needed to strengthen the cascade model of teacher training that had been adopted. Systematic research, monitoring and evaluation were essential, including follow-ups to baseline surveys. The Zimbabwean programme was well-designed, relatively inexpensive and replicable.     

Evaluation of HIV/AIDS peer education projects in Zambia

This 1998 evaluation assessed the peer education programmes of HIV/AIDS projects run by four non-governmental organisations. A mini-case study approach was used and analysis was based on cross-case itemistic variables. The projects were assessed only in terms of immediate developmental outcomes to target groups rather than on long-term impact. The study concluded the following: (1) The projects had raised community awareness of HIV/AIDS; (2) Basic knowledge of HIV/AIDS was for the most part accurate; (3) There was anecdotal evidence of behavioural changes in terms of partner-reduction as reported by the projects, though the evidence was sometimes conflicting; and (4) There was evidence that certain traditional practices, which contributed to the spread of the virus (e.g. sexual cleansing and scarification), were becoming modified over time. The programmes were also instrumental in protecting human rights and enabling people living with HIV/AIDS to maintain human dignity.     

Attitudes of Heterosexual Men and Women Toward HIV Negative and Positive Gay Men

Attitudes of Italian heterosexual men and women toward gay men, both HIV positive and negative, are poorly investigated. Italian culture is still extremely conservative and provides limited support to the gay community (e.g., lack of same-sex marriage recognition). Consequently, gay men experience social exclusion and disparities. The present study explores the association between homophobia and closeness with sexual orientation and HIV status. 261 heterosexual Italian men and women were assessed for feelings of closeness and homophobia after reading a vignette where the character was C1: heterosexual and HIV negative; C2: gay and HIV negative; or C3: gay and HIV positive. Experiences of homophobia and closeness varied depending on gender of participant and condition assigned, and higher levels of homophobia were correlated with lower levels of closeness regardless of HIV status. Implications and future directions are discussed.     

Resilience in low-income African American women living and aging with HIV

Women are living with HIV into middle and older age and are likely to face multiple comorbidities and stressors as they age. This study focused on understanding how women who experience multiple forms of oppression and ongoing adversity are still able to adapt and stand strong. Using a theoretical framework of resilience and a feminist research ideology, interviews of eight middle-aged and older African American women living with HIV were analyzed. Despite experiences of HIV-related discrimination, trauma, and violence, these women demonstrated a remarkable ability to adapt and maintain support. Implications for research and practice are discussed.     

The Socio‐Economic Determinants of HIV/AIDS Infection Rates in Lesotho,Malawi, Swaziland and Zimbabwe

Using data from the Demographic and Health Survey, this article analyses the relationship between HIV status and the socio‐economic and demographic characteristics of adults in Lesotho, Malawi, Swaziland and Zimbabwe. It constructs the risk profile of the average adult, computes the values of age, education and wealth where the estimated probability of infection assumes its highest value, and determines the percentage of adults for whom these three factors are positively correlated with that probability. It finds that in all four countries: (i) the probability of being HIV‐positive is higher for women than for men; (ii) the likelihood of infection is higher for urban than for rural residents; and (iii) there is an inverted‐U relationship between age and HIV status. Also that, unlike gender, rural/urban residence and age, the relationship between the probability of infection and wealth, education and marital status varies by country. The results provide support for country‐specific and more targeted HIV policies and programmes.     

A life of fear: Sex workers and the threat of HIV in Uganda

Schoemaker J, Twikirize J. A life of fear: sex workers and the threat of HIV in Uganda The way individuals perceive their risk to certain threats influences their adoption of preventive behaviour. This study explored sex workers' perception of risk of HIV infection within the context of other serious threats. The study was carried out in Kampala, Uganda, using peer ethnography. Sex workers were well aware of their risk of HIV infection but this risk was eclipsed by other more immediate and frightening threats. Sex workers' willingness to gamble with HIV is explained by the fact that their existence is already very dangerous, and taking risks is an inherent part of their trade. Decriminalising sex work could make their lives somewhat safer, motivating them to better protect themselves, but this is unlikely to happen in Uganda. Attempting to enforce some coercive control mechanisms would not work, given the pervasive corruption in law enforcement and the judiciary, the institutions that would be responsible for implementing such control.     

Effect of tuberculosis on immune restoration among HIV-infected patients receiving antiretroviral therapy

In this article, time to immune recovery during antiretroviral therapy was estimated and compared between HIV-infected children with and without tuberculosis (TB). CD4?T-cell restoration was used as a criterion for determining immune recovery. The median residual lifetime function, which is more intuitive and robust compared to the frequently used measures of lifetime data, was used to estimate time to CD4?T-cell restoration. The median residual lifetime is not influenced by extreme observations and heavy-tailed distributions which are commonly encountered in clinical studies. Permutation-based methods were used to compare the CD4?T-cell restoration times between the two groups of patients. Our results indicate that children with TB had uniformly higher median residual lifetimes to immune recovery compared to those without TB. Although TB was associated with slower CD4?T-cell restoration, the differences between the restoration times of the two groups were not statistically significant.